In May, 2013, the American Psychiatric Association came out with an all-new diagnostic manual, the DSM-5. This manual, sometimes called the "Bible" of mental health diagnosis, is important because it is used to determine who gets services, what kind of services they get, and whether or not they are eligible for particular forms of education.
Key Changes You Need to Know AboutWhat has changed? A lot!
1. Before May, 2013, there were five separate categories of autism diagnosis. Today, there is just one: Autism Spectrum Disorder. Whether your autism is very severe or relatively mild, whether your diagnosis was Asperger syndrome or Autistic Disorder, you are now grouped under the same umbrella diagnosis.
2. And before you ask, yes, if you already have an autism spectrum disorder diagnosis -- even one that no longer exists in the DSM -- you are still considered to be autistic. Here's what it says in the manual:
- Individuals with a well-established DSM-IV diagnosis of autistic disorder, Asperger’s disorder, or pervasive developmental disorder not otherwise specified should be given the diagnosis of autism spectrum disorder.
3. While there is just one autism spectrum disorder umbrella diagnostic code, clinicians are urged to also implement additional criteria which include levels of severity and specifiers to describe the unique features of his or her autism. Thus, you or your child can now be identified as having Autism Spectrum Disorder needing a particular level of support and with additional specifiers such as physical or psychological disorders or low intelligence.
4. If a person is newly evaluated or re-evaluated, and his or her features don't fit the criteria below, he or she may be given a brand new diagnosis, Social Communication Disorder, which looks suspiciously like the old PDD-NOS. Many are concerned that this new diagnostic category may wind up being a catchall which includes many people who have autism-like symptoms but are not eligible for the same services as people with autism.
4. Another important point, which you'll see repeated in the criteria below, is that symptoms must begin when a person is very young -- but even if symptoms have disappeared, a person is still considered to be autistic if they were ever diagnosed as autistic. Here's how that caveat is stated in the DSM: "Symptoms must be present in the early developmental period (but may not become fully manifest until social demands exceed limited capacities, or may be masked by learned strategies in later life)." This appears to suggest that even if a person has actually been successfully treated to the point that he or she is "indistinguishable from typical peers," he or she is not considered to be "cured."
The New Criteria for Autism Spectrum DisorderWondering what the "new" autism looks like? Here are the basic criteria:
A. Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history):
1.Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions.
2.Deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures; to a total lack of facial expressions and nonverbal communication.
3.Deficits in developing, maintaining, and understanding relationships, ranging, for example, from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to absence of interest in peers.
B.Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by history
1.Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypies, lining up toys or flipping objects, echolalia, idiosyncratic phrases).
2.Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat same food every day). 3.Highly restricted, fixated interests that are abnormal in intensity or focus (e.g., strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interests).
4.Hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment (e.g., apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement).
C.Symptoms must be present in the early developmental period (but may not become fully manifest until social demands exceed limited capacities, or may be masked by learned strategies in later life).
D.Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning.
E.These disturbances are not better explained by intellectual disability (intellectual developmental disorder) or global developmental delay. Intellectual disability and autism spectrum disorder frequently co-occur; to make comorbid diagnoses of autism spectrum disorder and intellectual disability, social communication should be below that expected for general developmental level.
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC.